Temporary arterial shunts in combat patient with vascular injuries to extremities wounded in Russian-Ukrainian war: A case report

Rogovskyi, Volodymyr M; Koval, B. M.; Лурін, І. А.; Гуменюк, К. В.; Gorobeiko, Maksym; Dinets, Andrii

doi:10.1016/j.ijscr.2022.107839

Cited by 14 publications

(10 citation statements)

References 16 publications

(25 reference statements)

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“…There were identified 374 male patients who were surgically treated at a military field hospital (Level II of medical care) situated in a 20 km zone from the frontline. The term “Level” is used in the National Military Doctrine of Ukraine, aiming to show the stratification of the five tiers in which medical aid is provided [ 3 , 6 , 7 ]. Each Level is a kind of medical tier to be organized on a progressive basis from 1 to 5 to apply treatment, evacuation, specific approaches to patient support as well as rehabilitation.…”

Section: Materials and Patientsmentioning

confidence: 99%

“…During the hybrid period of 2014–2020, and nowadays, we have noticed Russian army frequently uses various types of weapons with high damage properties ( e.g. hollow-point bullets), which is prohibited by international law [ 7 ]. Considering this fact, military medical officials in Ukraine came to the question of whether or not the abovementioned types of bullets impact the severity of gunshot wounds and specific locations of the injuries, as well as relations to the survival of the patients and their treatment.…”

Section: Introductionmentioning

confidence: 99%

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Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020

et al. 2023

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Background A gunshot wound to the colon is a frequent injury in armed conflicts. An example of a high-energy modern weapon is hollow-point bullets, which is associated with increased tissue damage and lethal outcome. The aim of this study was to evaluate gunshot injuries to the colon in combat patients and to assess the difference in clinical features of patients with colon injuries by hollow-point versus shape-stable bullets. Patients and methods Analyses of clinical data were performed on 374 male soldiers from the Armed Forces of Ukraine with gunshot abdominal wounds with injury to the colon in East Ukraine between 2014 and 2020. Out of 374 injured, 112 (29.9%) patients were diagnosed with penetrating gunshot bullet wounds: 69/112 (61.6%) were injured by shape-stable bullets, and the hollow-point bullets injured 43/112 (38.4%) patients. Results More severe hemorrhagic shock stages were in patients injured by hollow-point bullets: shock stages III-IV was in 25 (58.1%) patients injured by the hollow-point bullets vs. 17 (24.6%) patients injured by shape-stable bullets (p = 0.0004). Left colon parts were more frequently injured as compared to the right colon side or transverse colon: 21 (48.8%) patients were injured by the hollow-point bullets (p < 0.0001), and 41 (59.4%) patients were injured by the shape-stable bullets (p = 0.032). A significant difference was identified for the frequent injury to the middle colon within the entire cohort (p = 0.023). Patients injured by the hollow-point bullets demonstrated a higher frequency of 3–5 areas of colon gunshot defects, which was detected in 18 (41.8%) patients injured by hollow-point bullets and none with shape-stable bullets injury (p = 0.0001). Colon Injury Scale (CIS) IV was detected in 7 (16.3%) patients injured by the hollow-point bullets as compared to 2 (2.9%) patients injured by shape-stable bullets (p = 0.011). Colostomy was performed in 14 (69%) patients injured by shape-stable bullets and in 12 (27.9%) patients injured by hollow-point bullets (p > 0.05). 15 (35%) patients died after injury by the hollow-point bullet, whereas 9 (13%) patients after damage by the shape-stable bullets (p = 0.0089). Conclusions All patients should be suspected to have an injury by bullet with expanding properties in case of penetrating abdominal injury (absent of outlet wound) and careful revision of the abdomen must be performed to identify possible multiorgan injury as well as multiple gunshot defects of the intestine.

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Section: Materials and Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020

et al. 2023

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“…Patients are being evacuated to hospitals by train carriages that have been refitted with hospital beds, generators for oxygen and medical devices, as well as capabilities for intensive care en-route 17 . Polytrauma resulting from high-velocity penetrating vascular injuries, explosive injuries, traumatic brain injuries, and blast injuries have been the largest injury mechanisms reported 18 . Incendiary munitions have resulted in increased burns and organophosphate poisoning that present difficulties for care due to the consumption of medical resources 16 .…”

Section: Past Present and Future Analyses Of Lscomentioning

confidence: 99%

“…17 Polytrauma resulting from high-velocity penetrating vascular injuries, explosive injuries, traumatic brain injuries, and blast injuries have been the largest injury mechanisms reported. 18 Incendiary munitions have resulted in increased burns and organophosphate poisoning that present difficulties for care due to the consumption of medical resources. 16 More than 25% of patients present in hemorrhagic shock, however, the lack of power or the use of generators allows the detection of medical facilities limiting the storage and administration of blood products.…”

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Casualty care implications of large-scale combat operations

Remondelli

Remick

Shackelford

et al. 2023

J Trauma Acute Care Surg

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As modern battlefield preparations have shifted towards a focus on conflict against peer and near-peer adversaries, large-scale combat operations (LSCO) present challenges to casualty care on a scale not experienced since World War II. Medical evacuation capabilities are anticipated to be episodic. Prolonged casualty care will require massive consumption of far-forward medical resources and healthcare personnel, however, likely without access to protected medical facilities. LSCO will generate mass casualty events (MCE) requiring methods for triage to provide medical care for the “greatest good.” Blood product availability will continue to be a critical life-saving intervention as well as a constraint in an operational environment without prolific damage control surgical capability. Past and present experiences with LSCO combined with predicted future LSCO scenarios will challenge the feasibility and effectiveness of massive casualty response, triage, evacuation, logistics, surgical damage control, and hospitalization which will likely require the integration of civilian surgeons and trauma systems. In this paper, we will analyze challenges and discuss potential solutions to combat casualty care in modern LSCO.

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“…Open thoracotomy is the method of choice in gunshot injuries to the chest, and video-assisted thoracoscopic surgery (VATS) is uncommonly applied to remove foreign bodies [ 8 – 13 ]. It is also important to mention that the Armed Forces of Ukraine and civil people are in permanent violation of international humanitarian law during the war by the Russian army because of such high-energy weapons as artillery strikes, cruise missiles, and drone attacks on medical facilities, causing significant problems for the safe evacuation of wounded to appropriate levels of medical care and interruption in supplying of medical goods [ 2 , 14 – 17 ]. The management of all kinds of wounds is a difficult task for both civil people and military personnel under the abovementioned conditions.…”

Section: Introductionmentioning

confidence: 99%

Retrieval of ferromagnetic fragments from the lung using video-assisted thoracoscopic surgery and magnetic tool: a case report of combat patient injured in the war in Ukraine

Lurin,

Khoroshun,

Negoduiko

et al. 2023

Int J Emerg Med

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Background Gunshot wounds injury to the thorax is common in armed conflicts or war, including the war of Russia against Ukraine. Injury to the chest is associated with a high mortality or physical disability due to damage to the lungs, heart, and major vessels. The aim of this report is to demonstrate a case of successful management of severe gunshot injury to the lungs using video-assisted thoracoscopic surgery and magnetic tool for a combat patient injured in the war in Ukraine. Case presentation A 51-year-old soldier of the Armed Forces of Ukraine received a gunshot injury due to shelling from artillery strikes in the Donbas battlefield area. After evacuation to Level II, a forward surgical team performed primary surgical debridement. Two hours after the injury, the patient was evacuated to the Level IV of medical care (Kharkiv). At Level IV, a CT scan showed penetrating gunshot wounds to the left part of the chest with injury to the upper lobe of the left lung with the presence of the 2 metal fragments of the artillery projectile with the size of 2.5 × 2.0 cm and 1.0 × 1.0 cm. These two fragments were removed by using video-assisted thoracoscopic surgery (VATS) using the inlet gunshot hole in the left lateral chest area, as well as the assistance of a magnetic tool. Conclusions VATS and magnetic technologies should be considered for hemodynamically stable combat patients with a gunshot injury to the lungs in the ongoing war. Each combat patient could be treated by individualized approach such as using the wound canal as a scope port after primary surgical debridement of the wound and antibiotic prophylaxis.

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Temporary arterial shunts in combat patient with vascular injuries to extremities wounded in Russian-Ukrainian war: A case report

Cited by 14 publications

References 16 publications

Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020

Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020

Casualty care implications of large-scale combat operations

Retrieval of ferromagnetic fragments from the lung using video-assisted thoracoscopic surgery and magnetic tool: a case report of combat patient injured in the war in Ukraine

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